Provider Demographics
NPI:1588053029
Name:REAL FOOD LIFESTYLE, LLC
Entity type:Organization
Organization Name:REAL FOOD LIFESTYLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNEA
Authorized Official - Middle Name:MERRITT
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:520-289-6055
Mailing Address - Street 1:39131 S RODEO BUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-5933
Mailing Address - Country:US
Mailing Address - Phone:520-289-6055
Mailing Address - Fax:520-818-2939
Practice Address - Street 1:7400 N ORACLE RD
Practice Address - Street 2:SUITE 162-S
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6331
Practice Address - Country:US
Practice Address - Phone:520-289-6055
Practice Address - Fax:520-818-2939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty